The overall objective of this research project is to make a valuable contribution to the field of health outcomes research. This research project will focus on the causal effects of health insurance coverage on improved health outcomes - an increasingly policy relevant topic with the growing federal interest in healthcare reform. The project will implement a quasi-experimental study design that measures local-level variation in the availability of both private and public health insurance coverage. Variation in private health insurance coverage will be measured by local labor market conditions, and variation in public insurance coverage will be measured by state Medicaid and SCHIP eligibility rules. Various surveys from the National Center for Health Statistics will be examined to test for the effects of insurance coverage on improvements in morbidity, mortality, and access to care. For instance, limitations from chronic health conditions will be examined using the National Health Interview Survey, and infant mortality and access to prenatal care will be examined using the Vital Statistics Natality data. A multivariate regression framework will be used in which a particular health outcome will be the dependent variable for the analysis and measures of the availability of public and private health insurance will be the two key independent variables. The specification will allow for a direct estimate of the magnitude of the causal effect of insurance coverage on health status, and comparisons between the effect of public and private health insurance coverage on health status can be made. The results from this research project are especially relevant to both AHRQ's overall mission and policymakers interested in various options for healthcare reform; the anticipated (but currently not quantified) gains from improved health are often cited as a rationale for expanding health insurance coverage to the uninsured in the U.S. A secondary set of analyses in this research project will use spending data from the Medical Expenditure Panel Survey to produce estimates of the cost savings associated with the improved health outcomes analyzed in the primary set of analyses described above. As a result, the overall impact of healthcare reform proposals can be examined by comparing the federal and state spending on insurance expansions to estimates of the cost savings associated with improved health.